Table 2.
Heuristics and biases discussed in the text are presented alongside strategies for overcoming the pitfalls inherent to each.
Heuristic | Strategies to overcome systemic errors | Reference |
---|---|---|
Representativeness | Compare disease with prototypes of the condition; be suspicious when there is not a good match | 25 |
Be aware of relevant prevalence data | 25,80 | |
Incorporate discussion of common versus variant cases into educational practices | ||
| ||
Availability | Seek base rate of a diagnosis | |
Be aware of external influences in diagnostic process | 25 | |
| ||
Premature closure | Use tests or other exercises to refute diagnosis | 25,43 |
Differentiate working vs. final diagnoses | 25 | |
| ||
Anchoring | Insist on first hearing the “story” rather than someone else’s diagnosis | 25,41 |
Assess all key elements of the case | 41 | |
Avoid confirmation and early closure; make point of lab tests to “prove” other leading diagnoses. “Crystal ball” exercise | 43 | |
| ||
Confirmation | Use hypothetical-deductive method to assess value and role of contemplated tests | |
Try to disprove your diagnosis, consider conditions of higher prevalence | 25,43 | |
Stick to institutional protocols or standard methods when applicable | 36 | |
Be aware of affective, ethical and social influences | ||
Reaffirm role of intensivist as independent consultant; avoid influence of referring physicians | ||
| ||
Unpacking or support theory | Be aware that alternate descriptions of the same situation may elicit different estimates of likelihood. | 33 |
Unpack broad categories and compare alternatives at similar levels of specificity | ||
| ||
Satisficing | Perform secondary searches once it appears the answer is at hand. | |
Complete standard protocols where applicable. | 25 | |
| ||
Omission or status quo bias | Think of what others would do. Consider existing clinical evidence. | 37 |
Trust intuition: if you thought of it, you should probably do it | 25 | |
Try to approach each case as a clean slate, as in de-anchoring |